几种心肌损伤标志物对急性心肌梗死的诊断效率  

Efficiency of myocardial injury markers in diagnosis of acute myocardial infarction

作　　者：敬华[1] 李丹[1] 王晓非[1] 陈兴明[1] 高铁山[1] 杨晋德[1] 魏萍[1] 

机构地区：[1]解放军第306医院,北京市100101

出　　处：《总装备部医学学报》2005年第2期72-75,共4页Medical Journal of General Equipment Headquarters

摘　　要：目的研究肌钙蛋白I(TnI)、肌红蛋白(Myo)、磷酸肌酸激酶(CK)、磷酸肌酸激酶同工酶(CKMB)、高敏感C反应蛋白(hsCRP)等心肌标志物对急性心肌梗死(AMI)的诊断效率。方法选择AMI66例、心绞痛64例作为研究对象,TnI和Myo测定采用化学发光法,仪器为ACCESS;CK、CKMB等和用酶动力连续监测法,hsCRP用增强胶乳免疫浊度法,仪器为HITACH7060全自动生化分析仪。结果诊断AMI的敏感性和特异性分别为:TnI>0.05μg/L为96.96%和45.31%,TnI>0.5μg/L为84.45%和87.50%;Myo>70.00μg/L为93.99%和64.10%,Myo>100.00μg/L为90.91%和73.43%;CK>200U/L为81.82%和84.38%,CKMB>20U/L为81.82%和73.44%;hsCRP>3.0mg/L为93.75%和26.00%,hsCRP>6.0mg/L为88.24%和40.00%。联合诊断AMI的敏感性和特异性分别为:TnI>0.05μg/L+Myo>70.00μg/L为90.91%和89.10%,TnI>0.5μg/L+Myo>100.00μg/L为75.75%和100.00%,TnI>0.5μg/L或Myo>100.00μg/L为100.00%和65.60%,CK>200U/L+CKMB>20U/L为72.72%和89.06%。结论TnI>0.5ng/L+Myo>100ng/L可以单独确诊(尽管心电图没有Q波);TnI>0.5ng/L或Myo>100ng/L无论有无其它支持指标,可以按AMI进行诊断和治疗;CK、CKMB、天冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、α羟丁酸脱氢酶(HBDH)仍有一定的诊断价值。Objective To study the diagnostic efficiency of common myocardial markers:TnI, Myo, CK, CKMB and hs-CRP, both separately and in combination. Methods The myocardial markers were qualified and compared with each other in patients with acute myocardial infarction (AMI) (n=66) and angina patients (n=64). Results The sensitivity and specificity of AMI diagnosis were 96.96% and 45.31% when using TnI>0.05 μg/L as markers; 84.45% and 87.50% when using TnI>0.5 μg/L; 93.99% and 64.10% when using Myo>70.00 μg/L; 90.91% and 73.43% when using Myo>100.00 μg/L; 81.82% and 84.38% when using CK>200 U/L; 81.82% and 73.44% when using CKMB>20 U/L; 93.75% and 26.00% when using HsCRP>3.0 mg/L; 88.24% and 40.00% when using HsCRP>6.0 mg/L; 90.91% and 89.10% when using cTnI>0.05 μg/L combined with Myo>70.00 μg/L; 75.75% and 100.00% when using cTnI>0. 5 μg/L combined with Myo>100.00 μg/L; 100.00% and 65.60% when using TnI>0.5 μg/L or Myo>100.00 μg/L; 72.72% and 89.06% when using CK>200 U/L combined with CKMB>20 U/L, respectively. Conclusions TnI>0. 5 ng/L combined with Myo>100 ng/L helps to diagnose AMI definitely, either appearance of Q wave in ECG or not. TnI>0. 5 ng/L or Myo>100 ng/L support the diagnosis and clinical treatment of AMI. Traditional markers, CK, CKMB, AST, LDH and HBDH still have some efficiency in AMI diagnosis.

关 键 词：肌钙蛋白I 肌红蛋白 急性心肌梗死 诊断效率 

分 类 号：R542.22[医药卫生—心血管疾病]